Newbie and struggling with insurance

[pstarf 14]

Hi Everyone

I'm new here. I'm in the process of being approved for Gastric Sleeve Surgery. I have been through a multitude of tests lung, heart, psychiatric, etc... All of the docs I've seen feel I need the surgery.

Here's the issue... my current bmi is 38.57 so my insurance is saying they won't cover my surgery. I do have "co-morbidities" asthma, high cholesterol, lupus, heart murmur, reflux and a few others. These are not on the insurance company's approved "list".

As of right now... my option is to try to gain 10 pounds to get my bmi to 40 or fight the ins co. Had anyone been in a similar situation? Looking for support or suggestions. Thanks!

Edited September 16, 2016 by pstarf

[KristenLe 5,979]

Have you had a sleep study? sleep apnea would qualify you. I would fight! I think they'd deny if you gained weight. Take your height measurement again - we often think we are taller than we are!

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[pstarf 14]

Have you had a sleep study? sleep apnea would qualify you. I would fight! I think they'd deny if you gained weight. Take your height measurement again - we often think we are taller than we are!

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Thanks! have a sleep study scheduled but truthfully I don't think I have apnea. I do plan to fight it. It just stinks because I have so many health issues and my docs are so supportive and on board that it seems like it should be a no brainer for the ins. co. I've been going through the whole process and to be denied at the end is devastating.

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[KristenLe 5,979]

I can imagine. Have your Drs done a peer to peer review with the insurance?

[pstarf 14]

I can imagine. Have your Drs done a peer to peer review with the insurance?

No. What is that? I will do whatever is needed.

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[KristenLe 5,979]

The Dr talks to the medical director at the insurance about your case to see if they'll overturn the denial. Ask about it - I know it's worked before.

[pstarf 14]

Thanks!

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[WitchySar 244]

Does you insurance require a history showing your BMI as over 40? Some require like a 2 year history, others do not. If yours doesn't then I would suggest gaining weight. Doesn't sound like you need to gain too much, so head to a buffet, eat what you like, wear heavy clothes to the weigh in, put rocks in your pockets... whatever it takes to meet their magic number.

[pstarf 14]

Does you insurance require a history showing your BMI as over 40? Some require like a 2 year history, others do not. If yours doesn't then I would suggest gaining weight. Doesn't sound like you need to gain too much, so head to a buffet, eat what you like, wear heavy clothes to the weigh in, put rocks in your pockets... whatever it takes to meet their magic number.

I'm not quite sure tbh. It is the easiest route